|Year : 2014 | Volume
| Issue : 2 | Page : 185-187
AP Pichare1, AV Rujuta2, M Sanjeevani1, VP Baradkar3
1 Department of Microbiology, Maharashtra Institute of Medical Sciences and Research Medical College, Latur, Maharastra, India
2 Krishna Surgical Pathology Laboratory, Latur, Maharastra, India
3 Department of Microbiology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai, Maharastra, India
|Date of Submission||19-Oct-2013|
|Date of Acceptance||19-Dec-2013|
|Date of Web Publication||2-Apr-2014|
V P Baradkar
Department of Microbiology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai, Maharastra
Source of Support: None, Conflict of Interest: None
Cysticercosis is a disease caused by larval form of tapeworm. Cysticercus cellulose primarily develops in tissues of pigs. Infection of human tissues is unusual and affliction of the oral cavity is rare. We, herein, present a case of lingual cysticercosis without involvement of any other site. A 5-year-old male, non-vegetarian child presented with a painless, pearly white, solitary nodular swelling on posterior dorsal side of tongue since 3 months. Excision biopsy was done. Histopathology revealed cysticercous cellulose in tongue muscles.
Keywords: Cysticercosis, lingual child
|How to cite this article:|
Pichare A P, Rujuta A V, Sanjeevani M, Baradkar V P. Lingual cysticercosis. Indian J Med Microbiol 2014;32:185-7
| ~ Introduction|| |
Cysticercosis is an infection with the larval stage of Taenia solium. Infestation by Taenia solium is common in area where pig breeding is not controlled and sanitation is inadequate. Latin America, Southern Africa, India, Southeast Asia and Europe are the most frequent locations of occurrence.  The larval form of cyst is commonly seen in the brain, meninges and eyes.
Other sites reported are the muscles, heart, lungs and peritoneum.  Cases in the maxillofacial region including oral and cheek muscles, are rarely reported. As lingual cystercercosis is rare in occurrence, it creates diagnostic dilemma for clinician. Solitary nodule on tongue is not usually suspected as cysticercosis, and diagnosed usually only on histopathology examination. ,,,,,,,
| ~ Case Report|| |
A 5-year-old male, non-vegetarian child presented with a painless, pearly white, solitary cystic nodule near posterior-dorsal side of tongue since 3 months. Nodule was gradually increasing in size and causing discomfort while eating and talking. Examination revealed pearly white, smooth, non tender, solitary swelling of 1.5-cm diameter, on central posterior-dorsal aspect. No other organ was involved including CNS on radiological examination. Under local anaesthesia excision was carried out. On gross examination, it was pearly white, smooth, encapsulated, cystic nodule of 1.5-cm diameter with clear watery fluid. Inner surface was pearly white thin membrane.
Histopathology revealed cysticercous cellulose with scanty striated musculature [Figure 1]. Postoperative period was uneventful. Patient was given albendazole 200 mg for 30 days and was being followed up regularly and observed for neurological and ophthalmic signs.
|Figure 1: Histopathological section stained with H& E showing cysticercus cellulose (×400)|
Click here to view
| ~ Discussion|| |
Cysticercosis is an infection with cysticercus cellulosae, the larval stage of Taenia solium or pork tape warm. Taenia solium passes its lifecycle in two hosts. The definitive host is human who harbours the adult worm and intermediate host is pig which harbours the larval stage. The adult worm lives in the small intestine of man. Usually one adult worm is present which lives for years. It is about 3-m long with 1000 proglotids. The gravid segments have about 50,000 eggs in each segment.  The worm shed gravid segments laden with eggs in the stool which infect pigs. On reaching the alimentary canal of the intermediate host, these eggs rupture and oncospheres are liberated. They penetrate the gut wall and reach the systemic circulation and are lodged in the different organs and muscles of the intermediate host.  Here, they develop into larvae referred to as cystecercosis cellulosae. Human beings may accidentally or incidentally become the host of parasite in three ways: 1) Ingestion of food or water contaminated by infected human faeces containing Taenia Solium eggs. 2.) Oral transmission of eggs via the hands or carriers of the adult worm; and 3) Internal autoinfection by regurgitation of eggs into the stomach after reverse peristalsis. These are partially digested in the stomach, evolving to oncospheres and subsequently penetrating the small intestinal mucosa to disseminate throughout the body via arterio-venous channels and lymphatic, frequently encysting in subcutaneous tissue; striated muscles, brain and ocular tissue. ,,,,, Clinical manifestations of intestinal infection by Taenia solium could be asymptomatic or may present with epigastric pain, nausea and loose motions. In cysticersosis manifestations are different and depends on the location of cysticercosis in the body, not only this but also the number of cysticercosis at a particular site and the associated inflammatory response or scarring decides the clinical presentation. In 87% of cases, cysticercosis presents as a solitary lesion. Presentation as subcutaneous nodule on trunk, upper arm, eyes, neck, tongue, face and brain has been reported in this order of frequency. ,, Neurocysticercosis is most often presented with seizures and may be associated with subcutaneous nodules comprised extraneural cysts. Few cases of disseminated cysticercosis are already reported. ,,,, Oral cysticercosis can be another component of disseminated cysticercosis but isolated cyst in oral cavity are rarely reported. ,,,,, Our case is one more addition to this series of rare manifestation of cysticercosis. In spite of the abundance of muscular tissue in the oral and maxillofacial region, this is not a frequent site of occurrence for cysticercosis. The most frequently affected age was third to fourth decade with equal distribution between genders, but age was varied from 3 to 70 years. Authors from the school in Brazil, reported a rare and asymptomatic intraoral nodule in the right buccal mucosa of 7-year boy and biopsy of nodule proved the diagnosis as cysticercosis.  Usually, the patient complains of a swelling. Although pain is not a frequent feature, it had been reported in secondarily infected cases. It was suggested that the lesion on inner aspect of lip could interfere with movement of tongue, causing discomfort during speaking and eating.  Differential diagnosis of oral lesion depends on the site involved. In this case the differential diagnosis would be retention mucocele and oralfocal mucinosis. Histopathological examination makes up a diagnosis of cysticercosis by the detection of a cystic space containing the cysticercus cellulosae. The scolex has four suckers and double crown of rostellar hooklets. A duct-like invaginated segment, lined by a homogenous membrane, comprises the caudal end. The eosinophilic membrane that lines the capsule is double layered, consisting of an outer cellular and inner sparsely cellular layer. After a period, within 3 and 5 years the larva dies and the cyst undergoes calcification. Currently other diagnostic tool as radiological imaging and serology can be used. Besides normal radiographic examination, computerised tomography CT scan and magnetic resonance are very effective in the detection of cysticerci.  Saran et al.,  proposed the use of fine needle aspiration cytology, which identifies the tegument layer of the larva, to help the clinician in planning the treatment. Kamal et al.,  reported 10 cases of cysticercosis on cytology by cysticercosis cellulose, hooklet and fragments of wall with inflammation
Immunodetection of cysticercosis can be achieved in sera of cerebrospinal fluid and saliva by enzyme-linked immunosorbent assay (ELISA) or enzyme-linked immuneelectrotransfer blot (EITB), but it is important to consider that individuals living in endemic area may have antibodies because of an exposure instead of an established infection. Every case of oral cysticercosis should be thoroughly investigated to determine the involvement of multiple foci, since there is high incidence of such feature. Drugs as praziquanteland albendazole are potent antihelminthics used in the treatment of cysticercosis. ,,,,,,,, As the patient in the present case had nonoccurrence of cysticercosis at any other site or any other symptoms, no addition treatment was prescribed except the periodic follow-ups.
| ~ Conclusions|| |
is important to consider the diagnosis of cysticercosis in oral solitary cystic nodular lesion presenting in patients living in an endemic area. This case emphasises the role of the consultant doctor in the detection of disease that can have more serious involvement, as well as the importance of routine histological examination.
| ~ References|| |
|1.||Pandey SC, Pandey SD. Lingual cysticercosis. Indian J Plast Surg 2005;38:160. |
|2.||Bandyopadhyay D, Sen S. Disseminated cysticercosis with huge muscle hypertrophy. Indian J Dermatol 2009;54:49-51. |
|3.||Patel K, Shah M, Patel B, Doshi N. Subcutaneous oral cysticercosis. Natl J Community Med 2011;2:311-3. |
|4.||Sidhu R, Nada R, Palta A, Mohan H, Suri S. Maxillofacial cysticercosis: Uncommon appearances of a common disease. J Ultrasound Med 2002;21:199-202. |
|5.||Junior HB, Filho MR, Nogueira dos, Santos LA. Oral cysticercosis. Braz J Oral Sci 2006;5:1-11. |
|6.||Mishra YC, Nadkarni N. Oral-facial cysticercosis. Ann Dent 1988;47:23-5. |
|7.||Wadia N, Desai S, Bhatt M. Disseminated cysticercosis. New observations, including CT scan findings and experience with treatment by praziquantel. Brain 1988;111:597-614. |
|8.||Saran RK, Ratan V, Rajwansi A, Nijkwan R, Gupta SK. Cysticercosis of oral cavity: Report of five cases and a review of literature. Int J Paediat Dent 1988;8:273-8. |
|9.||Kamal MM, Grover SV. Cytomorphology of subcutaneous cysticercosis. A report of 10 cases. Acta Cytol 1995;39:809-12. |